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the treatment of ED. For the next 4 months, Pfizer’s switchboard was flooded with phone calls from the press, the public, and physicians (3). Print and broadcast coverage, including cover stories in Time magazine and Business Week, reached an estimated 140 million Americans—greater media attention than any other drug in history. At the same time, former presidential candidate Senator Bob Dole appeared on Larry King Live. Dole, a radical prostatectomy patient, had participated in the Viagra clinical trials. He endorsed Viagra, saying it was “a great drug” (3). Pfizer seized on this public announcement and engaged Dole in an ED public awareness initiative and its ads for Viagra. Pfizer’s marketing department had made several strategic decisions. The product would be a little blue, diamond-shaped pill. They also decided to use the recently proposed term “erectile dysfunction,” rather than impotence, “to remove the social stigma” (13). Among the wide range of marketing materials, they developed educational brochures specifically for doctors, because medical schools had not trained them on how to raise the delicate topics of sexual function and ED with their patients (3). Pfizer also invested considerable effort in preparing its sales force, because they anticipated Viagra would probably elicit jokes and off-color comments (3). The training was aimed at helping the sales staff become more comfortable talking about ED and ensuring that those conversations remained professional (13). One Viagra sales representative, Jamie Reidy, said Pfizer conducted hours of workshops and sexual harassment training, “especially for the female reps who were going to be talking about erections all day long” (13). Television advertising was also a challenge. At the time, media regulations prevented Pfizer from running its Viagra ad before 11:00 pm. Jennifer Doebler, Pfizer’s marketing director, had to “go and talk to every single network and make the case why they had to let the ad run before 11, when [our] target audience was awake and watching” (13).
A Blue Rocket Prior to Viagra, less than 10% of ED patients had sought treatment. Those who did start treatment often stopped (3). Coincidentally, Viagra reached the market just as the baby boom generation was transitioning into middle age. More than any previous generation,
the boomers wanted to continue living youthfully and deflected aging labels. They invested heavily in their health, including treatment for ED, which affects more than half of all men aged 40-70 (3). During the first 6 months of Viagra’s availability, physicians wrote 5.3 million prescriptions for it—the most successful introduction ever for a US drug. Within 18 months, it had captured 90% of the market (3). Every physician had stories to tell. Some extended office hours, including weekends, to accommodate the overwhelming demand. Some patients came in wearing a trench coat, hat, and sunglasses and refused to give their name. To avoid patient embarrassment, one doctor referred to it as Vitamin V. Another had a 90-year-old patient who unfailingly came every 3 months for a urological checkup, despite being “absolutely fit as a fiddle.” He was simply coming to get another pack of Viagra samples (13). Viagra unquestionably benefitted men, but the reaction among women was mixed. There were those like the woman who threatened to call off her wedding unless her fiancé (a participant in the clinical trials) could continue getting experimental sildenafil after the trial ended (3). But there were also wives who said, “I thought we were done with that” (13).
Changing Hearts and Minds Before Viagra, the prevailing view among experts, including Masters and Johnson, was that virtually all cases of ED stemmed from psychological causes (3). The relationship between ED and depression is complex, but Viagra was effective in men who suffered from both. In fact, Viagra treatment not only alleviated ED but also often reduced the symptoms of depression (3). Certainly, depression and anxiety are important factors. But the Viagra clinical trials confirmed that about 80% of ED cases are associated with underlying medical conditions like diabetes and hypertension, as well as physical damage from spinal cord injury or radical prostatectomy (3). Urologists had conducted most of the Viagra clinical trials, because ED was considered a subspecialty of urology, and urologists administered treatment (i.e. surgical implants or penile drug injections). But the Viagra trials made it clear that physicians across the entire medical spectrum would be prescribing it. Many men who had avoided routine checkups were now visiting their doctors, asking for
The Pharmacologist • June 2019